Incidence Of Breast Cancer In China Research Articles

Preoperative neoadjuvant chemotherapy in patients with breast cancer evaluated using strain ultrasonic elastography.

BACKGROUNDThe incidence of breast cancer in China is increasing while its mortality rate is decreasing. The annual breast cancer incidence in China is 39.2 million, accounting for two-thirds of the urban population. In China, breast cancer is the fifth most common malignant tumor overall and the most common in women, accounting for 17% of female malignant tumors. AIMTo investigate the accuracy of strain ultrasound elastography (SUE) on the evaluation of preoperative neoadjuvant chemotherapy (NAC) in breast cancer.METHODSOverall, 90 patients with breast cancer treated at our hospital between January 2018 and February 2019 were selected for this study. The patients received six cycles of NAC with docetaxel, epirubicin, and cyclophosphamide. Surgical treatment was also performed, and pathological reactivity was assessed. The patients were evaluated using conventional ultrasonography and SUE before biopsy. The differences between groups were analyzed to calculate the mean and standard deviation with significance measured using a t-test, while multivariate analysis was performed using logistic regression analysis.RESULTSOf the patients analyzed, 20 had a pathological complete remission (pCR) while 70 did not achieve pCR after NAC. The ratio of the elastic strain ratio (SR) and elastic score of 4–5 in patients with pCR were 5.5 ± 1.16 and 15.00%, respectively; these were significantly lower than those in patients without pCR (85%) and significantly higher than in patients without pCR (14%). SR and elastic score 4–5 were independent factors influencing NAC efficacy (OR=0.644, 1.426 and 1.366, respectively, P < 0.05). SR was positively correlated with elasticity score (rs = 0.411, P < 0.05). The area under the receiver operator characteristic curve of SR and SR combined with elastic score in predicting patients without pCR was 0.822 and 0.891, respectively (P < 0.05).CONCLUSIONStrain ultrasonic elastography may be used to evaluate the effects of preoperative NAC in patients with breast cancer.

A machine-learning approach for stratifying breast cancer risk in Chinese women on the basis of epidemiological factors and mammographic density

BackgroundAn accurate model to stratify breast cancer risk is required to move from a one-size-fits-all screening paradigm to more personalised risk-based screening strategies. Most risk models have limited accuracy and have been calibrated for white women. Considering the rapid increase in breast cancer incidence in China, in this study we aimed to develop a breast cancer model for Chinese women. MethodsWe recruited women from Fudan University Shanghai Cancer Centre. Information about their height, weight, body-mass index, age at menarche, age at first delivery, age at menopause, menopause status, parity history, number of children, breastfeeding history, personal history of breast cancer, family history of breast cancer, and degree of consanguinity was obtained. Mammograms were acquired from all recruited women. We used AutoDensity software to segment the mammographic dense area. To ensure that the breast density had not been affected by presence of the lesion, we measured the mammographic breast density of patients with cancer from the cancer-free breast contralateral to the biopsy-proven cancer. The breast area, dense area, percentage density, and demographic variables were input into an ensemble of 50 decision trees, the results of which we combined using a hybrid sampling and boosting algorithm (RUSBoost). The variables were also fed into the logistic and stepwise logistic regression models, which are two commonly used linear models. Leave-one-out cross-validation was used to assess the performance of the models and the receiver operating characteristics (ROC) curves were generated for each model. FindingsIn total, 1079 women (85 women with biopsy-proven breast cancer and 994 women without breast cancer) were recruited. The classifier had an area under ROC curve (AUC) of 0·86 (95% CI 0·82–0·89) for classifying the cases as normal or high-risk. It outperformed the accuracy of traditionally employed logistic and stepwise logistic regression models, which resulted in AUC values of 0·739 (0·67–0·81) and 0·757 (0·69–0·81), respectively. InterpretationWhen compared with linear models, use of a machine-learning approach, which models data non-linearity, could lead to improvement in the accuracy of a breast cancer risk stratification model. Such a model can be used to recommend intensified surveillance for women at a high risk of future breast cancer. FundingNone.

Recent insights into breast cancer incidence trends among four Asian countries using age-period-cohort model.

PurposeBreast cancer is one of the rapidly increasing cancers among women and a significant cause of cancer-related morbidity and mortality worldwide. Therefore, the current study was designed to examine and compare trends of breast cancer incidence (BCI) during the observed period (1990–2015) in specific age groups and investigate age-specific, time period, and birth cohort-related effects on BCI in China, India, Pakistan, and Thailand.Patients and methodData related to BCI were retrieved from the Institute for Health Metrics and Evaluation. Age–period–cohort model joint with intrinsic estimator algorithm was used to estimate the effect of age, period, and birth cohort on BCI. BCI rates were analyzed among different age groups ranging from 20 to 84 years in specified periods.ResultOverall, results showed an increasing trend of BCI among four Asian countries during the study period especially in age groups 50 to 84 years. Higher incidence rates were observed in 2015 in the age group 70–74, 65–69, 50–54, and 60–64 in Pakistan, China, India, and Thailand, respectively. Age period cohort analysis revealed significantly raised effect of age and period and declined effect of the cohort on incidence rates.ConclusionThe current study reported increased BCI with time in selected four Asian countries. Overall, BCI remained high in Pakistan as compared to China, India, and Thailand. Although proper registries are not available in most of the developing Asian countries, the current study highlighted the increased incidence and may play an essential role in registries development or spreading awareness against this disease. Therefore, maintaining proper records to build registries at the national level along with advancements in breast cancer screening and treatment are highly recommended to deal with the increasing burden of this disease.

Does hepatitis B virus infection cause breast cancer?

Lifestyle and family history are two of the most important risk factors for breast cancer (BC). However, these risk factors cannot explain the differences in the incidence and early BC onset among Chinese females compared to their western counterparts. We propose in this hypothesis the potential mechanism of indirect oncogenesis of hepatitis B virus (HBV) in causing BC through its persistence as occult infection and continuous replication with long term subtle liver damage. Estrogen is mainly deactivated in the liver and long term necro-inflammatory damage to liver may result in persistent high level of estrogen, which is a dominant risk factor for BC. HBV may also directly affect the breast cells through its cis and trans effects of HBx which may act as oncoprotein. Given the recognised aetiologic association between oestrogen and breast cancer risk, there is biological plausibility that dietary soy and vegetable intake which is rich in the Chinese diet may have anti-carcinogenic effect on the breast. The seemingly conflicting phenomenon of early age onset and lower BC incidence in China might be due to wide imbalance in the amount of exposure to carcinogenic factor (e.g., HBV infection) for decades and the carcinoprotective exposure levels (e.g., isoflavonoids and flavonoids intake). For example, the increase in carcinoprotective levels would lead to lower incidence of breast cancer and vice versa. Although the focus of this personal view is on HBV, this by no means negates the roles of other known risk factors in breast-cancer development. Characterisation of the role of HBV in BC could potentially benefit Chinese females by decreasing incidence and increasing overall survival.

Urban-rural disparity of breast cancer and socioeconomic risk factors in China.

Breast cancer is one of the most commonly diagnosed cancers worldwide. The primary aim of this work is the study of breast cancer disparity among Chinese women in urban vs. rural regions and its associations with socioeconomic factors. Data on breast cancer incidence were obtained from the Chinese cancer registry annual report (2005–2009). The ten socioeconomic factors considered in this study were obtained from the national population 2000 census and the Chinese city/county statistical yearbooks. Student’s T test was used to assess disparities of female breast cancer and socioeconomic factors in urban vs. rural regions. Pearson correlation and ordinary least squares (OLS) models were employed to analyze the relationships between socioeconomic factors and cancer incidence. It was found that the breast cancer incidence was significantly higher in urban than in rural regions. Moreover, in urban regions, breast cancer incidence remained relatively stable, whereas in rural regions it displayed an annual percentage change (APC) of 8.55. Among the various socioeconomic factors considered, breast cancer incidence exhibited higher positive correlations with population density, percentage of non-agriculture population, and second industry output. On the other hand, the incidence was negatively correlated with the percentage of population employed in primary industry. Overall, it was observed that higher socioeconomic status would lead to a higher breast cancer incidence in China. When studying breast cancer etiology, special attention should be paid to environmental pollutants, especially endocrine disruptors produced during industrial activities. Lastly, the present work’s findings strongly recommend giving high priority to the development of a systematic nationwide breast cancer screening program for women in China; with sufficient participation, mammography screening can considerably reduce mortality among women.

Environmental and DNA repair risk factors for breast cancer in South China.

The incidence of breast cancer (BC) in China has been rapidly increasing. We hypothesize that China-specific risk factors, both life-style and inherent ones, contribute to the problem. We have conducted an epidemiology and functional DNA repair investigation to identify risk factors for the development of BC in Shantou, China. Our survey of 372 patients and 419 matched normal controls confirmed the significant risk from many universal factors: high BMI, low education level, low fruit intake and sedate lifestyle. Significant risk factors can be organized into endogenous ones (low education and cooking with lard instead of vegetable oil) and externally-introduced ones (sedate life-style and cigarette smoking). We also found highly significant risk from passive exposure to cigarette smoke. Using the Challenge-Comet assay and blood samples from 57 patients who did not inherit the tumor suppressor BRCA gene mutations and 62 matched normal controls; we showed that reduced functional DNA repair capacity was a significant risk factor. In addition, the reduced repair capacity was associated with lymph node metastasis, and with tumors that had negative ER receptor and over-expression of Her-2. Our study indicates that combined externally-introduced and endogenous life-style factors were involved with the increased incidence of BC in China. We also showed, for the first time, that inherent deficiency in DNA repair function was a significant risk factor for BC. The inherent deficiency can interact with other risk factors to significantly increase risk for BC. In addition, the reduced repair capacity was associated with certain clinical features that are indicative of poor prognosis. In this context, it is possible to integrate DNA repair capacity knowledge in promoting prevention of BC and in enhancing personalized therapeutic protocols.

Abstract P6-05-23: An immunohistochemical study of folate receptor alpha status in breast cancers in Asian vs. North American women

Abstract Background: Folate receptor α (FRα) has been found to be over-expressed in several cancers, including lung, ovary, and breast cancers. Studies have also shown that over-expression of FRα in breast cancer strongly correlated with early recurrence and decreased median survival; thus, FRα has emerged as a potentially promising therapeutic target. Breast cancer rates among Chinese women have been shown to be much lower than women in many other racial groups. The breast cancer incidence in China per 100,000 people is only 18.7. China is ranked 142th in the world for this disease, compared to the top-ranking United States, which reaches 101.1 breast cancers per 100,000 people of all races and ethnicities. The disparity between the two groups led us to investigate and compare the immunohistochemical expression of FRα in breast cancers. Design: A new, highly specific clone of a mouse monoclonal FRα antibody, [26B3.F2], suitable for IHC, has been developed and well characterized on formalin-fixed paraffin-embedded tissue. A tissue microarray of 75 cases of breast cancer patients from China and 168 cases of whole tissues from North American patients were collected. Tissue was evaluated by immunohistochemistry (IHC) and stained for ER, PR, Her2 and FRα. A &amp;gt;1% cut-off value for ER/PR positive staining and a &amp;gt;10% cut-off value for FRα was adopted to determine positivity. Only 3+ Her2 positive cases were used in this study. Results: FRα expression was identified in 23.5% (57/243) of all breast cancers, with an increased incidence in ER-/PR- cases, and no significant difference between North American and Chinese populations (Tables 1&amp;2). In ER-/PR- patients, FRα expression was observed in 51.9% (14/27) and 40% (18/45) of cases from North American and Chinese populations, respectively, and only 6.7% (7/105) and 12.5% (3/24) of ER+/PR+ patients, respectively. FRα expression was also found to be significantly increased in ER-/PR-/HER2- (triple negative) cases across both populations; and FRα was positive in 52.4% (22/44) triple negative cases, compared to 30% (15/50) of HER2+ cases (p = 0.01). FRα was positive in 15.5% of ER+/PR+ vs. 44.4% of ER-/PR- cases, (p = 0.0001), and ER+/PR- cases also demonstrated higher FRα vs. ER+/PR+ in North American women. Table 1: North American women (n = 168)Antibody# casesHER2+FRα+ER+/PR+105 (62.5%)11 (10.5%)7 (6.7%)ER+/PR-28 (16.7%)9 (32.1%)14 (50.0%)ER-/PR-27 (16.1%)5 (18.5%)14 (51.9%)HER2+26 (15.5%)N/A9 (34.6%)ER-/PR-/HER2-22 (13.1%)N/A13 (59.1%) Conclusion: This study represents the first IHC FRα comparison study of breast cancers in Chinese and North American women. Our findings demonstrated that both ethnic groups demonstrated high expression of FRα in triple negative breast cancers and may identify a molecular subset of patients that would benefit from an anti-folate targeted therapy, including hormone receptor, or Her2 positive patients that have failed to respond to prior treatment, or triple negative patients for whom limited treatment options are available. Table 2: Chinese women (n = 75)Antibody# casesHER2+FRa+ER+/PR+24 (32.0%)3 (12.5%)3 (12.5%)ER+/PR-6 (8.0%)1 (16.7%)0 (0.0%)ER-/PR-45 (60.0%)20 (44.4%)18 (40.0%)HER2+24 (32.0%)N/A6 (25.0%)ER-/PR-/HER2-19 (25.3%)N/A9 (45%) Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-05-23.

Effects of Reproductive and Demographic Changes on Breast Cancer Incidence in China: A Modeling Analysis

Breast cancer incidence is currently low in China. However, the distribution of reproductive and lifestyle risk factors for breast cancer among Chinese women is changing rapidly. We quantified the expected effect of changes in breast cancer risk factors on future rates of breast cancer in China. We first validated and calibrated the Rosner-Colditz log-incidence breast cancer model in Chinese women who participated in the Shanghai Women's Health Study cohort (N = 74,942). We then applied the calibrated model to a representative sample of Chinese women who were aged 35-49 years in 2001 using data from the Chinese National Family Planning and Reproductive Health Survey (NFPRHS, N = 17,078) to predict the age-specific and cumulative breast cancer incidence among all Chinese women of this age group. We evaluated the relative impact of changes in modifiable risk factors, including alcohol intake, parity, postmenopausal hormone use, and adult weight gain, on cumulative incidence of breast cancer. Breast cancer incidence in China is expected to increase substantially from current rates, estimated at 10-60 cases per 100,000 women, to more than 100 new cases per 100,000 women aged 55-69 years by 2021. We predicted 2.5 million cases of breast cancer by 2021 among Chinese women who were 35-49 years old in 2001. Modest reductions in hormone and alcohol use, and weight maintenance could prevent 270,000 of these cases. China is on the cusp of a breast cancer epidemic. Although some risk factors associated with economic development are largely unavoidable, the substantial predicted increase in new cases of breast cancer calls for urgent incorporation of this disease in future health care infrastructure planning.

Increasing Breast Cancer Incidence in China: The Numbers Add Up

Increasing Breast Cancer Incidence in China: The Numbers Add Up